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WARNING! This form permanently transfers ownership of your FEGLI insurance to another individual, trustee, or corporation (however, premiums continue to be withheld from your salary/annuity). An assignment is irrevocable, and cannot be changed later. DO NOT USE THIS FORM if you only wish to designate a beneficiary to receive your life insurance. Instead, use the available designation of beneficiary form.
For more information about assignments and designations of beneficiary, see the FEGLI Booklet on Assignments, and Designation of Beneficiary and Order of Precedence.
FEGLI enrollees use this form to assign ownership of their life insurance coverage to another person, firm, or trust; and assignees use the form to reassign the coverage.
Request a paper copy of this form from your servicing Human Resources Office.